TNJ/NMBC ENTREPRENEURSHIP BOOT CAMP

REGISTRATION FORM

Name ________________________________________________________

Company Name ________________________________________________

Address _______________________________________________________

City ____________________________ State______ Zip __________

Phone __________________________________Mobile ________________________

Fax ___________________________________

E mail __________________________________

No of hours per week I can devote to my business _______

Average number of hours per day on the computer ________

Comfortable using/navigating Google and other search engines Yes___ No_____

Have an operating business/project Yes _____ No ______

If operating, number of employees __________

Most of my business exposure has been in:

1. Retail ____
2. Service ____
3. Manufacturing ____
4. Public Service ____
5. Other (Specify) ________________________________________________

No of hours of regular exercise per week _____________________

How did you hear about the NMBC Entrepreneurship Boot Camp ____________________

Payment: $150.00 (Options)

(1) Using Pay Pal go to E mail info@nmbcglobal.org for the account of the National Minority Business Council, Inc. and fax the Registration form to (212) 693 5048

(2) By check, Fax a copy of the Registration Form and the check to (212) 693 5048 and then mail to: National Minority Business Council, Inc.

Entrepreneurship Boot Camp

120 Broadway 19^th Floor

New York, NY 10271

(3) Other (Specify) _________________________